COVID-19-Induced Ischemic Infarcts With Normal Coagulation Profile and Excellent Outcome: A Case Report With Highlights on the Thrombotic Diathesis, Recent Transcranial Doppler Findings, and Neuropathology Update

We present the case of a previously healthy 41-year-old man right-handed man diagnosed with coronavirus disease 2019 (COVID-19) who developed multiple cortical ischemic infarcts. Our patient developed mild neurologic deficits despite the total volume of cerebral ischemic lesions, presumably due to involvement of non-eloquent cortex, the integrity of the collateral circulation due to his youth and good health, and mild COVID-19 disease without any significant pulmonary involvement. We discuss the coagulopathy and direct vascular effects, if any, of COVID-19 disease and compare it to other agents such as the filovirus, ad Ebola. We also outline the recent intriguing findings of vasodilation of the pulmonary vessels and the potential shunting of micro-emboli into the brain, which may explain the formation of embolic ischemic infarcts in even mild disease. Lastly, we discuss the neuropathology of COVID-19 in patients that who have succumbed to the disease and note the striking lack of direct involvement of the cerebral blood vessels.